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7/31/2019 Role of Health Policy in the Provision of Health Care
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THE ROLE OF HEALTHPOLICY IN THE PROVISION
OF HEALTH CARE
Department of Health Policy and
Administration
UP College of Public Health
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COURSE OBJECTIVES:
1. To define Health PolicyWhat is it?
2. To discuss the framework for health policy in
a developing country like the Philippines
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OTTAWA DECLARATION
Prerequisite to Health
peace,
shelter,
education, food,
income,
a stable eco-system, sustainable resources,
social justice, and equity.
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FIVE ACTION AREAS
Building healthy public policy
Creating supportive environments
Strengthening community actionDeveloping personal skills
Re-orientating health care services
toward prevention of illness andpromotion of health
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THREE BASIC STRATEGIES
Advocate
Enable
Mediate
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PRIMORDIAL PREVENTION
prevention of risk factors themselves,
beginning with change in social and
environmental conditions in which these
factors are observed to develop, andcontinuing for high risk children, adolescents
and young adults.
Amendable to policy
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WHY IS POLICY IMPORTANT
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WHY IS POLICY IMPORTANT
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DEFINITIONS: POLICY
Principles that govern action directed
towards given ends (Titmus, 1974)
Consciously chosen course of action (or
inaction) directed toward some end (Kalisch
and Kalisch, 1982)
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DEFINITIONPOLICY
Policy : a position taken on an issue by an
organization or individual in a position of
authority .
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IT CAN BE
Statement,
Decision
Document
Programme of action
Non action
A deliberate attempt to
block a decision
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THREE ELEMENTS OF POLICY
Concern with order, systematic and
consistent approach
Legitimatized by authority of
Individuals
Offices
Organization
Expertise
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HEALTH POLICY
Blanc and Burau (2004): those courses of
action proposed or taken by government that
impacton the financing and or provision of
health services
Health policy is about process and power
and how that happends
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WHAT IS POLICY
ATTRIBUTES OF POLICY
Belongingness : it belongs to someone or
somebody?
Government
Department
Party
Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000
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ATTRIBUTE OF POLICY
Policy denotes commitment .
stated intention
Desire to make things happen
Policy has status
It has the backing of some influential entity
Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000
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POLICY COMES IN DIFFERENT FORMS
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HOGWOOD AND GUNN (1984)
Policy as an aspiration or general purpose
We believe that the health of the nation is the
first priority is terms of public spending
Example :
Corruption will not be tolerated by the PNOY
administration.
The programs of the new administration will
be primarily for the poor and the
marginalized
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HOGWOOD AND GUNN (1984)
Policy as one proposal or set of proposal
Government declaring that it shall reduce
maternal mortality by 2/3 by year 2015
Health sector declaring its support to
Universal Health Care
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POLICY AS A PARTICULAR PROGRAM
Universal health screening (DEP ED)
The TB DOTS program
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POLICY AS A FORMALLY AUTHORIZED ACTION
When government states its intention in a
piece of legislation ( white paper, charter )
Health care organization publishes its
prospectus
Magna Carta for Health workers
Cheaper medicines act
Reproductive Health Bill
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POLICY AS A PROCESS
Process as the progress of any policy from
its original appearance on the agenda to its
eventual implementation ,review and
evaluation.
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POLICIES COMES IN DIFFERENT FORMS
Embodied in
Plans
Programs
Projects,
Decision,
Actions, Budgets,
Rules and regulations
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HEALTH POLICY
Public health policy
Health care policy
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HEALTH POLICY
An authoritative statement of intent
adopted by government on behalf of
the public with the aim of improvingthe health and welfare of the
populations (centrally determined
basis for action)
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WHAT IS HEALTH POLICY
What health agencies actually
do rather than what
governments would like themto do (Observing outcomes of
decision making).
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RATIONALIZATION OF VALUES
Heart of all political decisions is the allocation
of value.
Easton(1965) : allocation of values is the
process by which government choose which
values to grant and which to deny the
process of making and altering policies
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Inbox
Demands
Resources
Support
Policies are formulated, implemented
and if necessary revised
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What is the level of involvement of
government?
Government may choose to do nothing.
(policy of inaction)
Example : abortion, euthanasia
Policies are usually made within a framework
of competing values
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A SOCIAL PROBLEM IS NOT A SOCIALPROBLEM UNLESS THOSE IN POWER DECIDES
THAT THE ISSUE IS WORTHY OF ATTENTION
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LEE AND MILLS (1985)
Policy making is
concerned with what is
politically feasible and
technically desirable .
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FOUR KEY CONSIDERATIONS
1.Political pragmatism:
2. Ideological3.Financial
4.Moral
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ROLE OF THE STATE AND INDIVIDUAL ?
Individual and state
responsibility
Obligations or responsibility
Wearing of helmets,
Smoking in Public
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WHO DECIDES ? AND WHO ARE INVOLVED?
The consensus model -power granted to
governments by people through periodic
elections
Pluralistic model no one group holds totalpower.
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WHO DECIDES ? AND WHO ARE INVOLVED?
Elitist model -
government acts a honest brokers
reconciling the competing interest of different
groups towards agreed goals,
not all interest groups are equally powerful
or influential.
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POLICY NETWORK
Several organization collaborating in order to
plan a co-ordinated assessment and
provision of services.
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National Congress POLITICS International MDGs,WH0
Policies
DOH
PHILHEALTH
Academe
Local
Provinces, City ,Municipalities
WHO ARE THE ACTORS ?
Problems
Health needs and
demands
PEOPLE
in theCommunity
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DEFINITIONS: POLICY
Policy encompasses the choices that a
society, segment of society, or
organization makes regarding its goals
and priorities and how it will allocate its
resources.
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POLICY PROCESSHOW ARE POLICY MADE?
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RATIONAL MODEL
Step by step procedure
Highly logical and carefully sequenced
Does not allow for competing rationalities
Considered too prescriptive
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INCREMENTALISM (LINDBLOM,1959)
Muddling through a decision
Incremental change
Involves mutual adjustments and negotiation
Excludes options by accident
Policy is not made once and for all Proceeds through a series of incremental
changes
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INCREMENTALISM (LINDBLOM,1959)
The test of good decision is agreement
rather than meeting of objectives
It involves trial and error
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POLICY ANALYSIS: RATIONALIST MODE
Problem Analysis
1. Understanding the Problem
a. Receiving the problem:
Assessing the symptoms
b. Framing the problem :
Analyzing market andgovernment failures
c. Modeling the problem:
Identifying policy variables
2. Choosing and explaining relevant
goals and constraints
3. Selecting a solution method
Solution Analysis
1. Choosing impact
categories for goals
2. Concretely specifying
Policy alternatives
3. Predicting impacts of
Alternatives
4. Valuing impacts of
Alternatives
5. Evaluating and
Recommending
Communication
Information Gathering
Identifying and organizingrelevant data, theories, and facts forassessing problems and predicting consequences of current and
alternative policies
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Policy Formulation
and Legitimation
Implementation Design and
Organizational Structuring
Resource
Mobilization
Progress/ImpactMonitoring
ConstituencyBuilding
Agendas
Decisions
Issues
= primary linkage
= secondary linkage
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AGENDA SETTING
What is an agenda? The list of subjects or problems to which government
officials (or several sectors) are paying some seriousattention to.
Process of agenda setting:
Getting an Issue recognized
Identification of a policy problem Nature of the problem affects how it gets into the
agenda and the course of action
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POLICY PROBLEM
A condition or situation that produces needs
or dissatisfaction on the part of the people for
which relief and redress is sought
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WHAT IS AN ISSUE /PROBLEM
Widespread attention to , or at least
awareness of the issue
Shared concern of a sizeable portion of the
public that some type of action is needed toremedy the problem
A shared concern that the matter is an
appropriate concern of some governmentalunit and falls within the bounds of its
authority.
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POLICY ANALYSIS: RATIONALIST MODE
Problem Analysis
1. Understanding the Problem
a. Receiving the problem:
Assessing the symptoms
b. Framing the problem :
Analyzing market andgovernment failures
c. Modeling the problem:
Identifying policy variables
2. Choosing and explaining relevant
goals and constraints
3. Selecting a solution method
Solution Analysis
1. Choosing impact
categories for goals
2. Concretely specifying
Policy alternatives
3. Predicting impacts of
Alternatives
4. Valuing impacts of
Alternatives
5. Evaluating and
Recommending
Communication
Information Gathering
Identifying and organizingrelevant data, theories, and facts forassessing problems and predicting consequences of current and
alternative policies
How do issues get on to the policy agenda?
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How do issues get on to the policy agenda?
Problem Policy (Solutions)
No Change
No Change
No Change
Politics (Political
will)
ACTION
No Change
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FRAMEWORKS OF POLICY DEVELOPMENT
Policy Making
Policy Analysis
Policy Research
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Initial
Agreement(Plan for
Planning)
Issue
Problem
Formulation
Creation
Search for
Solution
Policy of
Plan orFormulation
Proposal
Review andAdoption
Implementation
And Evaluation
Policy or Plan
Maintenance,
Succession orTermination
Triggering
Mechanisms
Containment
Mechanisms
Public Agenda Formant Agents
The Policy Environment
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Evidence DataResearch Knowledge
ResearchersandUniversities
Advocates PolicyBrokers Media
BELIEFS
CausalAssumptions
COREVALUES
Ideologies
INTERESTS
FORMALSTRUCTURE
Executive
Legislative
Bureaucracy
INFORMALSRUCTURE
Networks
Coalitions
Stakeholders
Citizens
SocialProblem/
Issue
Policies
VALUES
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QUICK AND DIRTY POLICY ANALYSIS PROCESS
Source: Patton and Sawicki, 1993
Verify, Define, Detail
the PROBLEM
Establish
EVALUATIONCRITERIA
Identify
ALTERNATIVE
POLICIES
EVALUATE
alternative policies
MONITOR the
implemented policy
DISPLAY and
DISTINGUISH
among alternatives
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COMMITMENT .
To search for the
COMMON GOOD
Through Health Policy Development